Luminary Health
Luminary Health Partners, PLLC
2200 Riverside Parkway, Suite 310, Austin, TX 78701
(512) 555-0142 · billing@luminaryhealth.com
Riverside Clinic · Dr. Samuel Ortiz, DO
Invoice
HP-1209
- Issued
- 08-20-2026
- Payment
- HSA
Billed to
Dana Kim
DOB 06-27-1990
1520 Mesa Verde Ct, Austin, TX 78745
(512) 555-0162 · dana.kim@example.com
Rendering provider
Dr. Samuel Ortiz, DO
Riverside Clinic
| Description | Enc. | Qty | Unit price | Amount |
|---|---|---|---|---|
Physical Therapy Session Service· HP-1020 · CPT 97110 | 1 | 2 | $110.00 | $220.00 |
B12 Injection Service· HP-1011 · CPT 96372 | 1 | 1 | $35.00 | $35.00 |
- Subtotal
- $255.00
- Total due
- $255.00
Linked encounters
1
08-20-2026 · Blood Pressure Recheck
Telehealth · Dr. Samuel Ortiz, DO · Northgate Clinic · note-8554
Assessment
Borderline hypertension, improved with lifestyle change.
Plan
Continue current measures. Repeat recheck in 6 months.
Supports:Physical Therapy SessionB12 Injection